CDC: 2020's Rise in STIs Exposed 'Crumbling Public Health Infrastructure' – Medpage Today
Gonorrhea and syphilis infections rose in 2020, including congenital syphilis, while declines in chlamydia infections were likely tied to lack of screening, CDC officials said on Tuesday.
Syphilis infections rose 10% versus 2019, while congenital syphilis was up 15% and a 7% increase in gonorrhea was observed. More worryingly, congenital syphilis has increased by 235% since 2016.
Chlamydia infections, which comprise the largest proportion of sexually transmitted infections (STIs) in the U.S., declined 13% compared with the prior year. This was attributed to the fact that chlamydia is asymptomatic, and usually detected during sexual health screening, which was disrupted during the pandemic.
The 2020 STD Surveillance Report found 1,579,885 reported cases of chlamydia, 677,769 cases of gonorrhea, 133,945 cases of syphilis, and 2,148 cases of congenital syphilis, resulting in 149 stillbirths and infant deaths. Overall, 61% of chlamydia cases were among individuals ages 15-24, while men who have sex with men (MSM) accounted for 53% of all syphilis cases.
Jonathan Mermin, MD, CDC’s director of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, said that the COVID pandemic came during a difficult time for STI control, thanks to a “crumbling public health infrastructure.”
He added that a variety of factors combined to exacerbate trends of STI incidence, such as diversion of public health workers to respond to the COVID pandemic, lapses in health insurance coverage due to unemployment, and reduced frequency of STI screenings, due to fewer in-person healthcare visits.
Indeed, CDC data showed that gonorrhea cases were up 45% and syphilis cases were up 52% since 2016.
But the increase in congenital syphilis was the most dramatic, and Leandro Mena, MD, director of CDC’s Division of STD Prevention, hypothesized that the increase was a result of risky behaviors, such as injection drug use, meth use, and sex with partners who inject drugs.
Mena also pointed to unstable housing and lack of medical insurance as potential factors, and stressed the need to address “prevention gaps for women who may not have health insurance.” He added that MSM and young people “bear the brunt of the epidemic,” including individuals from racial/ethnic minority groups, such as Black, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander.
“Lack of access to regular medical care, discrimination, and stigma continue to stand in the way of healthcare,” Mena said, adding that we need to understand that the “system creates inequities.”
Healthcare providers play an increasingly important role to help reduce stigma by “integrating STI prevention and sexual health [screening] into routine practice” and creating a “welcoming environment to all people.”
Mermin pointed to “multi-sector solutions” — both on the community level and the clinical level — and stressed the need for more accessible STI testing in community-based organizations beyond the clinic.
He also called for “new scientific discoveries” in the field of STIs, noting that vaccines against gonorrhea, chlamydia, and syphilis are needed. Patients also need “treatments that are more easily taken than the ones we have” and more accessible point-of-care testing, he said.
“There is much to be done to rebuild, innovate, and expand STI prevention,” Mermin said.
Molly Walker is deputy managing editor and covers infectious diseases for MedPage Today. She is a 2020 J2 Achievement Award winner for her COVID-19 coverage. Follow
